Enhancements to ClaimsXtenTM Code Auditing Tool

November 21, 2012

Blue Cross and Blue Shield of New Mexico (BCBSNM) will implement an expanded version of the ClaimsXten code auditing tool, with the new 2013 CPT/HCPCS codes and additional bundling logic, into our claim processing system beginning on or after Feb 25, 2013.

The ClaimsXten tool offers flexible, rules-based claims management with the capability of creating customized rules, as well as the ability to read historical claims data. ClaimsXten can automate claim review, code auditing and payment administration, which we believe results in improved performance of overall claims management.

To help determine how coding combinations on a particular claim may be evaluated during the claim adjudication process, you may continue to utilize Clear Claim ConnectionTM (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSNM’s code-auditing software. Refer to the Education and Reference/Provider Tools section to view additional information on gaining access to C3.

Please continue to watch this website for News and Updates on the ClaimsXten implementation and other BCBSNM programs and initiatives.Additional information also may be included in upcoming issues of the Blue Review.

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for its products and services.